OPINION AND ORDER Plaintiffs the Medical Society of the State of New York, the Society of Office Based Surgery Facilities, and Columbia East Side Surgery, P.C. (“Columbia”), bring this class action under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§1001, et seq., against Defendants UnitedHealth Group Inc., United HealthCare Services, Inc., United HealthCare Insurance Company, United HealthCare Service LLC, Optum Group, LC, Optum, Inc., and Oxford Health Plans LLC (collectively, “United”). United has now moved to strike the expert report of Michael Miscoe (Dkt. No. 158), and moved for summary judgment (Dkt. No. 161). For the reasons that follow, Defendants’ motion to strike is denied and Defendants’ motion for summary judgment is granted in part and denied in part. I. Background The Court assumes familiarity with the background of this case, as set forth in this Court’s prior opinions. Med. Soc’y of the State of N.Y. v. UnitedHealth Grp. Inc., 332 F.R.D. 138, 143-45 (S.D.N.Y. 2019); Med. Soc’y of the State of N.Y. v. UnitedHealth Grp. Inc., No. 16 Civ. 5265, 2019 WL 1409806, at *1 (S.D.N.Y. Mar. 28, 2019); Med. Soc’y of the State of N.Y. v. UnitedHealth Grp. Inc., No. 16 Civ. 5265, 2018 WL 1773142, at *1 (S.D.N.Y. Apr. 12, 2018); Med. Soc’y of the State of N.Y. v. UnitedHealth Grp. Inc., No. 16 Civ. 5265, 2017 WL 4023350, at *1-2 (S.D.N.Y. Sept. 11, 2017). Additional facts most relevant to the motions pending before the Court are briefly recounted below. United processes the vast majority of its health benefit claims using an automatic benefit claim adjudication system. (Dkt. No. 170 54.) While United asserts that the system “allows [it] to automatically process benefit claims in accordance with the coverage provisions of each individual plan…[by] follow[ing] the logic of the plan terms for each claim adjudication” (id.), Plaintiffs dispute that the auto-adjudication system applies the language of the plan terms with respect to the coverage of facility fees for office-based surgery (“OBS”) providers. (Dkt. No. 183
54-56, 59, 62-64, 379-416.) United asserts that it is the industry standard to “presumptively follow” Medicare’s billing practices. (Dkt. No. 170 15.) As part of those billing practices, Medicare does not pay facility fees to OBS providers. (Dkt. No. 170
